Nutrition Scope of Practice Revisited

Fitness Forum: Should we deconstruct boundaries for giving food/nutrition advice to apparently healthy clients?

As an ACE-certified group fitness and personal training professional, I found “Food and Nutrition R/Evolution” (Warm-Up, November–December 2011) fascinating. I have recently earned my MS degree in nutrition, and I am currently working as a dietetic intern in Chicago as I prepare to become an RD. I am an avid reader of your journal, especially the nutrition-related portions. I want to share a few thoughts regarding questions posed in the editorial.

1. Should we deconstruct boundaries for giving food/nutrition advice to apparently healthy clients?

How can you talk about fitness and health but leave out the topic of food? I agree with you that food is medicine and has tremendous healing power for any individual. However, I tread with caution on the topic of “deconstructing boundaries.” Even if a person is apparently healthy, it is impossible to know about his past medical history without an in-depth interview by a qualified professional. An outwardly healthy person can be diseased or at-risk internally. Further, with eating disorders as prevalent as they are, it is important to approach the topic of eating with a trained eye in order to appropriately assess but not trigger any disordered eating patterns related to weight or intake.

2. Could fitness professionals have more of an impact on client success if they could do more in the food/diet/nutrition area?

Of course. Working out is 30–60 minutes of most clients’ days; nutrition choices can happen during the other 15 waking hours. A client’s success relies on her diet as well as her fitness. However, I believe that working as a team can be a powerful thing. Maybe instead of encouraging fitness professionals to practice nutrition, we should encourage them to become educated in that arena, or we should collaborate with nutrition professionals when working with clients.

3. Do you push out your boundaries in the interest of helping clients?

I would do anything in my power for my clients at the gym and for my patients at the hospital. I care for them all so much. However, in order to protect clients and patients alike, it is very important to work within our knowledge and scope of practice. A proper referral can be the best help we can offer a client in need.

4. Do you feel your scope of practice limits you and your clients?

Fitness professionals know so much about kinesiology, proper technique, motivation, heart rate, balance, training different age groups, educating clients and promoting health (among many other specialties). Our scope of practice is large. We also know about good nutrition, but do all of us have the education and credentials to practice it?

The other day I was at my gym, and a personal trainer was asking a client about her food intake over the past week. The trainer advised the client to incorporate whole foods (instead of processed) and fresh veggies into her diet. Is this within the scope of practice? Absolutely. So is discussing proper hydration after a workout. But I’m not convinced that writing diet plans or prescribing supplements is appropriate or within the scope of practice for fitness professionals.

We need more professionals on the nutrition team. Doctors and nurses often do not have much education in this realm and may or may not urge patients toward preventive care as dietitians and fitness professionals do. I just want to make sure that by deconstructing we don’t work outside our scope of practice.

Ginger Hultin, MS
Chicago, Illinois

I am very excited to hear that IDEA is open to discussion about the limitations placed on fitness professionals in the area of nutrition.

Having previously worked in a small facility with healthcare professionals, I certainly understand the need for caution when incorporating food, nutrition and diet counseling into a fitness professional’s scope of practice. There is so much bad information out there that, without care, we could cause more harm than good. However, if we have proper training and solid, evidence-based facts, I truly believe we are doing our clients and our industry a disservice if we stay within some of the very strict restrictions placed upon us.

I have personally been through the weight loss battle and have kept the excess off (60 pounds for 16 years now) through quality nutrition and exercise. I have worked with licensed healthcare professionals and have learned a lot from them, but I am unable to share or use a lot of the information with my clients. While working with these highly qualified professionals, I saw on several occasions the ineffectiveness of simply referring clients to RDs. Don’t get me wrong—I respect RDs’ work (my mother is one); however, their skills seem to be mostly geared toward clients in a clinical setting or toward those who already have major health issues. There doesn’t seem to be much, if any, guidance given to clients who need behavior modifications—just “Eat this, not that.” What about those who are in between? Because of so much conflicting diet advice and aggressive marketing, it’s easy for clients to be confused and to make even worse dietary changes (e.g., by turning to fad diets) or to give up.

As an ACE-certified personal trainer and lifestyle and weight management consultant in Missouri, I am still very restricted. I would love to be able to offer more nutrition guidance to clients, but there is no middle ground. Please keep this discussion going among those who can effect the most change in the industry.

Thank you, and keep up the great work!

Deanna Ledbetter, CPT, LWMC
Wellness Coordinator
St. Louis, Missouri

I think that fitness professionals helping clients more with nutrition would be an awesome opportunity. I believe that exercise and food go hand in hand. I train a large variety of clients, and many of them ask, “What should I eat?”

Our society has trained us to eat poorly and quickly, which means consuming processed foods and fast foods that are literally killing people. I suggest nutrition books and coaches to clients all the time, but no one takes the extra step. Clients believe that as a trainer I should give more advice on food. I’ve considered investing in the holistic food health-coach education, but a revision in policies would be awesome!

Thanks for all you do and all the information you provide.

April Doherty
Bel Air, Maryland

Does IDEA Validate the Research It Presents?

I am quite perplexed and puzzled by the feature article on Daniel Amen, MD, by Mary Monroe [“It’s All in the Brain: Unlocking the Secrets of Overeating With Neuroscience,” November–December 2011]. My first question is: Does anyone check the “research” used to support the claims of the “authorities” quoted? If you do a modicum of research regarding Dr. Amen’s claims, you quickly find there is no validated research to support them. Dr. Amen is, most likely, the consummate marketer, but lacks good scientific research to back up his assertions. I realize that your publication is not a science journal per se but as a fitness professional for over 20 years, I expect more of a journal that is not only to inform, but supposed to educate professionals in health and fitness. I continue to take classes for CEUs and to make sure the information I impart to my clients is the most accurate and valid based upon the facts currently available and supported by sound science backed by peer-reviewed research. I expect a widely read and respected fitness publication such as yours to hold yourselves to the highest editorial standards and to be able to provide support for the claims made in your articles.

Jack Cotter
ACSM Health and Fitness Specialist

Editor’s note: Thank you for your response to the article and for your interest in quality research for fitness professionals. We agree that this is critically important to our industry! In fact, an extensive list of peer-reviewed research for Dr. Amen’s book as well as his CV are available on Dr. Amen’s website www.amenclinics.com. Please click on “The Science” at the bottom of the home page. Regarding Dr. Amen’s original studies, as we reported in the article, functional neuroimaging tools have been used to evaluate overeating and obesity for only about the last 5 years. There is not yet a conclusive body of supporting research available. However, we felt Dr. Amen’s groundbreaking research, given his lengthy and respected experience in the field, was of interest and value to fitness professionals.

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February 2012

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